Day 22...

...or should I say Day 1???  First the counts:

Hemoglobin 9.3
WBC 0.8
Platelets 77
|Neutrophils| 0.1
Creatinine 1.40

I'm currently receiving my first dose of my fourth round of chemotherapy.  Dr. Oran met with me today and we decided to go with FLAG again.  My primary concern was that a second dose would not be aggressive enough, leaving me out of remission and out of transplant again.  Dr. Oran believes that since the first round was so effective there's a good chance another is still my best option, especially since I have such little ground to cover.  She also explained that with ALL a bone marrow biopsy needs to be performed once the counts have returned in order to obtain an accurate measurement of surviving blasts within the marrow.  Complete destruction of ALL marrow blasts require an immune system to clean up dying blasts.   With AML you can biopsy at day 14 for an accurate blast count.  Eg:  This summer I was sent home after a biopsy revealed approximately 9% blasts.  About a month later the biopsy was completely clear.  This remaining 9% were dying ALL-like blasts that my immune system was able to whack.

With FLAG comes Decadron, the dreaded but useful steroid I was receiving before, and (you guessed it) the insulin drip.  Boo hourly glucose checks...

I will also have a chest CT this week to check on that sneaky fungus.  Although I remain asymptomatic we should know what it is up to.

I hope this is strong enough to put me into remission.  No two rounds of chemo are the same, even if pharmacologically identical.  We'll see how FLAG treats me in the rematch.